Clinical Management

The first line agent for fascioliasis is bithionol, which is used at a dose of 30-50 mg/kg on alternate days for 10-15 doses and has an efficacy ranging from 58% to 100% (Table 17.6) (Arjona et al., 1995; Bacq et al., 1991; Bassiouny et al., 1991; Farag et al., 1988; Farid et al., 1990). Frequent side effects include photosensitivity, vomiting, diarrhea, abdominal pain and urticaria. Rarely, leukopenia or hepatitis may occur. Unfortunately, bithionol is no longer manufactured and its availability is limited. In the USA, the CDC provides bithionol for domestic use only, while in many countries, such as the UK, it is unavailable. While praziquantel is efficacious for most trematode infections, it has had limited success with treating fascioliasis. The results have been disappointing, with cure rates of 0-71% (Arjona et al., 1995; Farid et al., 1986, 1989; Knobloch et al., 1985). Praziquantel is not currently recommended for treatment. Previous to bithionol, the drug of choice was emetine or dehydroemetine, which had a 93% cure rate in one series (Chen and Mott, 1990; Hardman et al., 1970). The major drawback to this drug is its toxicity, including cardiac side effects with hypotension and prolongation of the QT interval on ECG. Other drugs being tested experimentally include nicofolan, metronidazole and albendazole, with case reports of successful use (Eckhardt and Heckers, 1981; Nik-Akhtar and Tabibi, 1977).

Table 17.6 Treatment of fascioliasis

Drug

Total daily dose (mg/kg) and duration

n

Efficacy (%)

Study

Side effects, comments

Bithionol

25, 10 days

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